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Montana rates for HCPCS A5513

For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each

Facilitymedian $52 · 10th–90th $36–$660%20%10th90th$52Professionalmedian $39 · 10th–90th $17–$720%10%10th90th$39$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $26.92 / $72.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $52.48
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $56.23 / $56.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $56.23 / $56.23
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $52.48 / $102.33
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $52.48 / $102.33
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $50.12 / $64.57
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $56.23 / $79.43
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.18 / $38.02 / $41.69
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $24.55 / $38.90